Wednesday, August 2, 2017

Clinical Relationship Killers (Part 1)

Unrealistic Expectations, the Extremes

So, you expect your psychiatrist to be M*A*S*H’s Dr. Sydney Freedman’s identical twin? Remember the character?

Dr. Freedman’s god-like Clinical Skills
  • A fountain of unrivaled clinical insight
  • An unfailingly compassionate listener
  • Infinitely intuitive
  • Perfect couch-side manner
  • Witty

Let me break it to you gently. Your psychiatrist is not Sydney Freedman. In fact, no psychiatrist is. Dr. Sydney Freedman is a unicorn. He doesn’t exist. Unions are perfect and imaginary. Sydney Freeman is perfect and imaginary. I wonder how many people left treatment because their very human psychiatrist didn’t measure up to an ideal.

The opposite extreme to the good Dr. Freedman, Hannibal Lecter:

Hannibal’s Satanic Clinical Skills
  • He’s a sociopath
  • He’s a serial killer
  • He’s a cannibal

Let me reassure you. Your psychiatrist isn’t a serial killer and he doesn’t want to have you as a meal. 

Dr. Lecter is a fictional character designed to scare the daylights out of movie audiences. I wonder how many people decided not to seek needed treatment because their darkest irrational suspicions about psychiatrists were given a face.
Taming expectations is crucial.

Real-World Psychiatry
          Some psychiatrists are truly gifted. Just as some orthopedists and family physicians are. If you are the patient of a truly gifted MD, treasure him or her.
  •      Remember however, that gifted doesn’t mean Dr. Sydney Freedman.
  •      Most psychiatrists are in the “mushy middle.”
  •      If you find yourself dissatisfied with aspects of your Dr.-patient relationship, the growth potential for you is huge.
  •      Working through your dissatisfaction with him will reap enormous clinical benefits for you.
  •     I will explore at great length in future blog posts various dissatisfaction we patients have and strategies for working through those complaints with our MDs.
  •     Don’t bail on a “mushy middle” clinical relationship. Work through the conflicts.     

My book Finding My Voice: A 20-Year Psychiatrist-Patient Odyssey is about resolving clinical struggles and creating transformation. I know this subject well.
 A few psychiatrists should be in the lab, not with patients. Every field of medicine has those rare practitioners who should be doing something else. Psychiatry is no exception.
  •     Make every attempt to work through the conflicts with your physician.
  •     Seek assistance from your psychotherapist. She can intervene on your behalf
  •     If there is no resolution, get a second referral.
  •     Don’t stay in an unhealthy or destructive clinical relationship with any physician or psychotherapist
  •     Fortunately, this is an uncommon occurrence

The next “Relationship Killer” post will be on “negative mindreading” or the tendency for those of us in treatment to presuppose our clinicians’ meaning or intent. A lot of needless injury is caused by assuming the worst about a clinical insight your psychiatrist or psychotherapist has shared with you. Negative mindreading is a trap to be worked through and avoided.

Credit: Photo image 2

Monday, July 24, 2017

Preparing for Your First Psychiatrist Appointment

In the previous blog posts, I walked you through the strategy of finding your psychiatrist. Now what happens? First, check-in with yourself. Are you anxious or afraid of this upcoming appointment? Preparation is power. Take that power; don't give it away for ultimately, your psychiatrist wants to help you heal. 

The Basics

  • Make sure you have good directions to his office. Getting lost stinks on your first day.
  • Call his office in advance and ask the office manager about parking availability or bus line access
  • Remember your insurance card and copay. Ask the office manager what copay method is accepted. Surprises on your first appointment are anxiety-producing
  • Make an outline of the essential pieces of information you want the MD to know. Write them down. If you get nervous, sometimes remembering what you want to say can be a challenge.
  • Arrive at least 15 minutes early. Not just because of paperwork but also because it gives you time to collect your thoughts and get familiar with his waiting room. The first thing I noticed about Dr. Rosen’s waiting room was his artwork. Finding something to focus on in a new environment that’s calming is a big plus. Review your notes for the appointment. Ground yourself with the reasons you are there. This is your big WHY.
  • Most psychiatrist appointments run pretty much on schedule, barring emergencies. If you show up too late you will have to reschedule. Not what you want on your first appointment.
  • Remember, he’s in this branch of medicine to help people struggling with mental illnesses. He’s not going to judge you. 
What You Can Expect at Your First Appointment

  • Your psychiatrist will greet you and usher you into his office.
  • He’ll introduce himself and ask how he can help you
  • Get out that piece of paper that has your main concerns on them. Share your list with him.
  • He’ll ask you lots of questions about your life experiences, background, how you spend your time, what you enjoy doing.  He’s trying to get to know you as a person. Answer as honestly as you can. Check-in with yourself and see if you feel he’s engaged in your answers
  • He’ll ask you about medications and medical issues you may have so he has a complete picture of you, physically, emotionally, and psychosocially.
  • He’ll then discuss your symptoms and how he feels he can help
  • He'll then give you his clinical insights. Listen closely to his thoughts. Active listening paves the way to healing Ask him questions if you don’t understand what he is explaining.
  • Sometimes our psychiatrists give us feedback we aren’t happy with. Don’t disregard his clinical judgement because it makes you uncomfortable. Tell him his insights are uncomfortable for you. He’ll address your concerns without judgement.

·         Ending the appointment

  •       Ask where he has hospital admitting privileges
  •       Ask how to contact him if you have an emergency
  •       He’ll tell you when he wants to see you next
  •       He may give you a prescription
  •       He may give you orders for medical tests
  •       He may want another appointment to get more information from you before he decides on a treatment.

·         Deciding whether to return is a hard choice. Things to keep in mind:

  •      Building a trusting relationship takes time
  •      Unless the MD was a complete disaster, give the relationship time
  •      Follow his instructions and make the next appointment with his office manager.
  •      Spend some quiet time going over everything the physician said and what you think about his clinical advice. Be open minded.

In the next post, I’ll discuss expectations. The single biggest killer of a psychiatrist-patient relationship or psychotherapist-client relationship is having unrealistic expectations.

Over to You!

Learn more about my groundbreaking book on how I ultimately found healing and joy from cementing a 20 year collaboration with my psychiatrist Dr. Y. Read more about this book and how it can help you here. 

Follow me over on my Facebook Fan page where I often have light hearted conversations about what people often think of as dark topics.  Think of them as your daily dose of inspiration. We don't want to drag you guys down!

Photo credit 1

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Wednesday, July 12, 2017

Finding Your Psychotherapist Match: The Strategy

Finding the right psychotherapist for you isn’t as easy as picking a name off an insurance provider list and showing up in their office. If you want the best chance at good chemistry, you need to have a plan to find Psychotherapist Right.

So... How do you pick a psychologist or psychotherapist?

1.Assess your needs. Do you need someone to help you sort out complex issues or pesky life’s problems?  Ask yourself “what do I most need right now?” Make a list in order of your priorities.
      2.Check with your insurance provider. Find out what categories of professionals are covered under your plan.

  •      For example, my plan only covers psychiatrists and psychologists. Because of my complex illnesses, that’s a good fit for me.

      3.This is the research project part.

  • Find 3-4 names of providers. Maybe your family doctor, clergy, friends or family have suggestions.
  • Be careful that you don’t pick a provider that your friends or family are currently seeing. That is a conflict of interest for the provider.
  • Creating your own list of providers is a place to start.


4.If you aren’t self-pay, check to see if any of the providers from your list are covered under your insurance.
  • Cross off the ones that aren’t.
  • In a pinch, pick a few names off of your insurance policy provider list. This is the equivalent of cold calling for a therapist. Not the most effective approach but sometimes it’s your only option.
5.Call each psychotherapist/psychologist on that list you created.
  • Leave a message saying who you are, how to reach you, when to reach you, and a brief description of why you are calling.
  • Consider writing down the message you want to leave before you call. That way, you’ll know what you said to each provider and you’ll also get your key points into the message.

6     6. When they call you back, treat the call as a phone interview. You are interviewing them. Take notes
  • Ask about their training, expertise (including the therapeutic technique they use), and experience
  • Pay attention to how thoughtfully they answer your questions
  • Give them a brief description of your major issue
  • Pay attention to their answer. Did they listen? Do they come across as knowledgeable and empathetic?
  • Keep a notebook of their answers and your impressions

7     7.If you find one or two you’d like to meet in person, make appointments.

       8. This is the face to face interview. You are trying to make a match for yourself. The little things matter.
  • Gender may be important to you.
  • Their demeanor may be important to you.
  • Age may matter to you.
  • The office style may matter to you.
  • The convenience of parking or bus access might be a deal breaker.
  • Do their appointments run on time?
  • You won’t know the answers till you go and scope them out.
9.As you enter into your hour-long session, check-in with yourself. How does this interaction feel to you?
  • Are you at ease or vaguely uncomfortable? Does your provider notice if you are uncomfortable? How do they help you resolve your discomfort?
  • Are you getting good feedback that you find helpful
  • How is their listening style. Do you feel heard?
  • Is there anything in the session that is off-putting to you?
10.After you have compared and contrasted your face to face interviews, either make a selection for a second appointment or start gathering more names. The fit between you and your psychologist or psychotherapist is important. You’ll be sharing deep parts of yourself with them probably every week. That’s a lot of contact. Keep in mind that you have many options to choose from with psychotherapists. It’s okay to be a bit picky.

Read this post for the strategy for finding your psychiatrist-patient match. Psychiatrists are trickier to scope out. 

First of all, they are MDs. How many people get in depth research information about their dermatologist? Second, psychiatrists are a pretty rare breed. There just aren’t that many to choose from. You have much more limited options than with psychotherapists.

Friday, July 7, 2017

About My Book: Finding My Voice: A 20 Year Psychiatrist-Patient Odyssey

Somebody, please, tell me why am I dragging myself into my psychiatrists office every month and swallowing all these pills when its not helping!! Tragically, when this plea finds no insight, treatment is either abandoned or the patients doctor hop. Patients scour physician directories hoping to discover that one unicorn MD with the magic elixir.

The abandoned truth is that even though imperfect, psychiatry, with physician and patient persistence, can be effective. Sticking it out can mean a breakthrough. The physician doesnt even have to be a unicorn to make a difference in a patients life. For people like myself, treatment can be restorative and it is often our last best hope to conquer complex and lethal illnesses. This may be unpopular to say, but psychiatry just does not get enough credit for all the human triumphs, big and small, it cultivates.

Its easy to harshly criticize the fields painstakingly slow methods and very public failures. However, in hospitals, medical arts buildings, and private offices, quiet victories occur with stunning regularity. The delicate work of Drs. and patients too often go unnoticed and uncelebrated.

It is appalling that there are so few published personal accounts of these psychiatrist-patient expeditions. If a struggling human being thinks that they travel alone, where does the inspiration to swallow one more pill or share one more symptom come from? This book is remarkable, not just because it shines a light on the hope embedded in psychiatric treatment, but also because the odyssey it details is unique.

My story chronicles the birth, nurturance, and maturation of my two decade long therapeutic bond with my psychiatrist. This journey begins at the precipice of madness and continues through to the resurrection and redemption of a brutalized psyche. Our psychiatrist-patient relationship isnt perfect but it is enduring and transformative. 

Weve hung in there with each other against some pretty overwhelming odds. Along the way, weve learned a few things about converting treatment failure into triumph.
It has been by facing our faults and celebrating my many conquests that we continue to sojourn together. To the person struggling to stay in treatment, my odyssey is meant to be a glimpse into the possible. My profound regret is that more of these healing journeys are not shared.

Finding Your Psychiatrist Match: The Strategy to Making an Appointment

This post is the first in the series on finding the right psychiatrist that suits your needs and the strategies to making an appointment. 

Finding the right psychiatrist is a bit of a different process from finding your psychotherapy match. Since psychiatrists are MDs, their time is limited, and there are far fewer of them than psychotherapists. Your approach needs to be different.

How do you pick a psychiatrist?

The most common route to an appointment with a psychiatrist is through a referral by your psychotherapist.

  • Many psychotherapists have the names and contact information for one or two psychiatrists available for quick reference.
  • If your psychotherapist doesn’t have a working relationship with a psychiatrist and she wants an evaluation, she has colleagues that can provide the MD reference.
  • It’s important to know that if your psychotherapist is recommending a psychiatrist, they should provide you with a referral to someone they trust.

The second route to an appointment with a psychiatrist:

  • Best to get a referral to a psychiatrist from another physician or healthcare professional. MDs work closely with other MDs.
  • When getting the referral ask questions about the psychiatrist’s success rate, how collaborative he is with your physician, and how long your MD has worked with the psychiatrist.

Once you have a referral either from your psychotherapist or your healthcare provider, check your insurance and verify the psychiatrist is covered under your policy.

  • If he is, you are ready to make an appointment
  • If you plan to be self-pay, you can call without this step.
What you need to know about making your appointment
  • Like most physicians, psychiatrists have office managers/receptionists. You will most likely be making your appointment through this person.
  • It’s important that the receptionist listens, is polite and helpful. If you become this Dr's patient, the receptionist is the gate keeper to your access with him. You need a good relationship with her. Start out on a good footing.
  • Tell her that you are a new patient being referred by [name your referrer].
  • If she says the Dr. is no longer accepting new patients, you need another referral.
  • If he is accepting new patients, ask for the first available appointment.
  • She will ask you many questions to get your contact and insurance information into their computer system.
  • She will ask you about your insurance and confirm for you that the psychiatrist accepts your provider.
  • At the end of the call you should have a date, time, and office location for your appointment.
  • The wait time for your appointment varies depending on your psychiatrist’s available office hours and schedule demands.
  • The length of your first psychiatry appointment varies by what the MDs preference is. 45 minutes for a first appointment is common.

In the next post, we’ll examine what you can expect at your first appointment with your psychiatrist and some clues that the relationship has promise.

To learn more about my treatment story, click here.

To learn more about my book Finding My Voice- A 20 Year Psychiatrist - Patient Odyssey, click here.  

Thursday, June 8, 2017

About Me: Shoshana Stein

So, what’s my treatment story?

I am being treated for 2 chronic mental illnesses: complex trauma and bipolar 1 disorder with psychosis.

For 21+ years I have been under the gifted care of one psychiatrist, Dr. Y. You might say we grew up together. I began treatment with him when he was straight out of residency and I was on the edge of a state hospital commitment. I was at the nadir of my life and he was a wet-behind-the-ears MD. We both had a lot to learn, and we learned together.

My psychologist of 7+ years, Lynn, is trauma treatment brilliant. I’d like to take a wee bit of credit for her becoming interested in trauma therapy. Before my case, she had an awareness of severe trauma. After becoming my psychologist, she got interested in focusing her practice on the disorder.

Before Lynn, there were a series of therapists, each of whom taught me valuable skills. For 12 years I worked with Nancy, a psychologist, who taught me how to parent after a year-long hospitalization and separation from my daughter. 

She followed a psychologist, Carrie, who helped me untangle how exactly I evolved from a professional scientist to a psychiatric patient needing long-term commitment.

My very first psychotherapist was Sue. She presided over my downward spiral into the depths of psychiatric hell. She’ll come up over time.

Why listen to my insights?

  • ·         15 years of giving and receiving mental health support in group, online, and one-on-one settings
  • ·         BS in psychology, BS in chemistry, graduate work in biochemistry and toxicology
  • ·         I’ve made the transition from total disability to full-time professional employment as a scientist
  • ·         I wrote a book about the psychiatrist-patient therapeutic relationship from the patient’s perspective, which you can read more about here.

Perfecting the Chemistry in your Psychotherapeutic Relationships

Hi, I’m Shoshana Stein, a veteran of the psychotherapeutic process

  • Are you thinking about seeing a psychiatrist or psychotherapist?
  •  Maybe you made a first appointment and panic is setting in?
  • Perhaps you are in treatment and it’s not what you expected?

Let’s Start with The Basics: The Accredited and Certified Mental Health Professions

You know something’s wrong. Maybe a spouse, boss, or friend pointed it out, or in your gut, you know you are struggling. So, what kind of help is there out in the world for what gnaws at you?

Psychiatrists and Psychotherapists, The Differences

·         They are physicians. MDs.
·         They prescribe medication and treatment for brain illnesses that appear as disturbances in behavior, perception, and thought.
·         They can admit and treat people with in-patient hospital admissions
·         Very few psychiatrists perform psychotherapy.
·         They do refer their patients for psychotherapy if needed

  Clinical Psychologists
·         They are not MDs. They do not prescribe medication
·         Psychologists have doctorates or master’s degrees
·         They have undergone rigorous training, testing and licensing.
·         They are trained to administer psychological tests
·         They are expert with problems ranging from struggles with your child to coping with a significant mental or physical illness.
·         If they believe you need an MD, they will refer you.
·         It is a catch-all title for mental health professionals who engage in talk therapy. They can be licensed clinical social workers, masters degreed social workers, counselors, etc.
·         They may have master’s degrees or bachelor’s degrees
·         They have undergone rigorous training, testing and licensing.
·         They are trained to engage in mental health treatment
·         They will also refer you to a psychiatrist if they see a biochemical component to your issues.

These are the professions that will provide you with the expertise you need to help you with your struggles.

Focus your search on evidence-based psychotherapeutic techniques and practitioners. You will have the best possible outcome. Evidence based techniques have been evaluated through scientific research for effectiveness. There are different kinds of effective techniques and one will be right for your unique struggle.

So, how do you find the right psychotherapist or psychiatrist for your needs?  There’s a strategy for finding your match. In the next blog we discuss how to find the best psychotherapist for you.